# Tracheal agenesis diagnosed by supraglottic airway–assisted endoscopic evaluation during neonatal resuscitation: a case report

## TL;DR

A rare case of tracheal agenesis was diagnosed using a supraglottic airway during neonatal resuscitation, enabling endoscopic evaluation and timely diagnosis.

## Contribution

This case report demonstrates the utility of supraglottic airway-assisted endoscopic evaluation in diagnosing tracheal agenesis during neonatal resuscitation.

## Key findings

- Supraglottic airway placement allowed partial ventilation and endoscopic evaluation in a neonate with suspected tracheal agenesis.
- Endoscopy revealed a blind-ending subglottic pouch and tracheoesophageal fistula, consistent with tracheal agenesis.
- Computed tomography confirmed the diagnosis of Floyd type II tracheal agenesis.

## Abstract

Tracheal agenesis is an exceptionally rare and typically lethal congenital airway anomaly presenting with failed intubation. We report a case of unrecognized tracheal agenesis in which supraglottic airway-assisted ventilation enabled concurrent fiberoptic endoscopic evaluation during neonatal resuscitation.

A preterm male neonate born at 31 weeks and 1 day of gestation with polyhydramnios and suspected duodenal atresia developed severe respiratory failure immediately after delivery. Repeated attempts at tracheal intubation were unsuccessful despite vocal cord–like structures being seen. Placement of a size 0.5 supraglottic airway (Air-Q®) resulted in transient partial ventilation with intermittent colorimetric carbon dioxide detection, permitting fiberoptic endoscopic evaluation. Endoscopy demonstrated a blind-ending subglottic pouch and a distal tracheoesophageal fistula, strongly suggesting tracheal agenesis; computed tomography subsequently confirmed the diagnosis of Floyd type II tracheal agenesis.

Early supraglottic airway-assisted endoscopic evaluation may facilitate rapid recognition of tracheal agenesis during neonatal resuscitation and support timely, multidisciplinary decision-making after failed intubation.

The online version contains supplementary material available at 10.1186/s40981-026-00852-w.